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I am dismayed to see Joseia's post regarding RNs in acute care and wonder where he derives his information. Kaiser's Inpatient services is NOT loaded with 400 plus nurses perusing magazines and PDAs! Though Kaiser proposed to layoff 400 RNs in 21 northern california hospitals, unilateral suspension of contractual no-cancel protections have not resulted in an average cancels of even 40 'idle' RNs a day. Joesia misrepresents Kaiser's offer of training positions. RNs supporting families cannot leave their jobs to go to positions without benefits or set working hours. How could rent or bills be paid without reliable working hours? Regardless of training positions, hospitals are grossly understaffed. RNs are desperately trying to maintain safe patient care without adequate staffing, as nurses will attest by the frequency of working through meals and breaks! Currently RNs work 24-32 hours a week (not at Joesia's inflated wages), extra shifts and overtime to plug the gaps in shifts where patients lack sufficient cores of RN staff. RNs then take time away from families to leaflet hospitals to bring patient safety concerns to public attention. RNs work hard in a physically and emotionally challenging environment. Joesia's characterizes CNA RNs as being dishonest, but CNA is truthfully representing RNs and authentic healthcare.

I have seen hospital care in Walnut Creek become a game of Russian roulette due to the lack of RN staff allocated for inpatients' treatment. Admissions are deferred until patients are extremely ill. Patient placement on admission from the ER is haphazard depending on which unit has staff, resulting in higher acuity patients at lower levels of care. All nursing departments rely heavily on RNs accepting 12 hour or 16 hour shifts to meet patient needs, resulting in fatigue linked to preventable human error. Many shifts run without adequate numbers of RNs to meet patient requirements. Members pay premiums their whole lives for treatment when they become most sick and vulnerable, only to be sent home from the ER multiple times, placed on observation status while inpatient (and pay more healthcare costs when discharged from observation status) or face early discharge and readmission. Unlicensed Assistive Personnel take a greater percentage of acute care time, diluting inpatients' access to the clincial expertise from RNs and in defiance of research demonstrating RN practice improves patient recovery. The quality of hospital care patients receive is eroding at a fantastic rate under the cover of the ACA expansion of outpatient services. Members have their healthcare denied or degraded to the lowest common denominator by hospital executives seeking a larger slice of the patient care dollar. Doctors and administrators who benefit from the denial of hospital care are silent, hiding behind the massive organization's control of patient outcome data and public relations spin. Kaiser has joined the billion dollar healthcare industry and consortium that is slashing holes in the acute care safety net by mariginalizing RN's efforts to uphold standards for safe patient care. RN reports of unsafe patient care conditions in the hospital are ten times the number submitted three years ago. RNs advocate for patients in a system that is increasingly fragmented, based on technological algorhithms and disconnected from human needs.